Y's MEN INTERNATIONAL
		US AREA SUPPLY OFFICE
		PURCHASE ORDER FORM
Date
Name						Tel:
Street Address						e-mail:
City,State,& Zip						Fax:
Club Name						Region
I.D. No		Description				Quanity	Unit	Total
							Price	Price
						Sub Total $
						Add 10%
MAKE CHECKS PAYABLE TO :
						Total $
Y'S MEN INTERNATIONAL US AREA
MAIL TO:	Long Beach Uptown Y's Men Club				Fax 1-562-598-0208
	c/o Tibor Foki				Alternate Contact:
	3462 Marna Avenue				Tibor Foki
	Long Beach Ca 90808-3126				3462 Marna Avenue
	Phone 1-562-598-0208				Long Beach, CA 90808-3126
	e-mail fokiscopeit@hotmail.com				Phone 1-562-598-0208
					e-mail fokiscopeit@hotmail.com
					Fax 1-562-598-0208